The Initial Fundus Examination and Severity of Diabetic Retinopathy at a Primary Eye Clinic

PURPOSE: This study was performed to determine the time of initial fundus examination after the diagnosis of diabetes and the probability of diabetic retinopathy in the primary eye clinic. METHODS: 158 diabetes who visited on primary eye clinic between September 2003 and February 2004 were enrolled. We perfomed fundus examination with stereoscopic photograph. and made some questions about the delyed fundus examination. RESULTS: Among 158 patients (Mean age 59.56 +/- 9.66), diabetic retinopathy was demonstrated in 59 (37.3%). The average delayed time of initial fundus examination was 5.98 +/- 5.30years. The longer duration of the interval, the higer was the prevalence of diabetic retinopathy and the more severe retinopathy was found. The common reason of delayed fundus examination after diagnosis of diabetes was `having no symptom' (50.0%) and `not knowing of diabetic ocular complication' (15.0%). CONCLUSIONS: We concluded the prevalence of diabetic retinopathy in primary eye clinic was not remarkable different in tertiary hospital. In order to prevent vision threatening diabetic retinopathy, We should perfom the fundus examination before becoming too advanced. In primary eye clinic as well as tertiary hopital, education of diabetic patients and thorough understanding of diabetic retinopathy must be needed.

Vitreous Levels of VEGF and Surgical Outcomes after Vitrectomy in Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the levels of vascular endothelial growth factor (VEGF) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and to find any correlation between clinical and fundus findings, grade of PDR, post-operative complications and surgical outcomes. METHODS: Using ELISA, the vitreous concentration of VEGF was measured in 74 patients with PDR who had undergone vitrectomy and in 13 control patients. RESULTS: The pre-operative levels of VEGFin the vitreous of the PDR patients was significantly increased compared with those of the control and with the post-operative levels. The pre-operative VEGF concentration in the vitreous of the PDR patients was correlated with the duration of diabetes and the severity of proteinuria, but not with the type of diabetes, level of HbA1c, hypertension and BUN/creatinine levels. The severity of PDR was also correlated with pre-operative VEGF levels, especially in NVD, NVE and NVI, but was not correlated with vitreous hemorrhage and fibrous proliferation elsewhere. There was negative correlation with the severity of retinal detachments. The vitreous levels of VEGF in PDR were significantly lower in those who had received previous laser photocoagulation than in those who did not. The VEGF levels were also significantly elevated in patients who developed NVI or NVG in the post-operative period. The changes of visual acuity after vitrectomy in the PDR patients were not correlated with vitreous levels of VEGF. CONCLUSIONS: These results show that VEGF is related to intraocular angiogenesis, progression of PDR and post-operative complications such as NVI or NVG, and that panretinal photocoagulation could prevent the progression of PDR.

A Case of Wegener's Granulomatosis Misdiagnosed as Ocular Tuberculosis

PURPOSE: To report a case of Wegener's granulomatosis misdiagnosed as ocular tuberculosis. METHODS: A 65-year-old man who was treated with anti-tuberculosis medications as suspected pulmonary tuberculosis was referred from the department of internal medicine for visual loss over months. His initial visual acuity was counting fingers at 30 cm in the right eye and there was a chorioretinal scar involving the macula on fundus examination. At that time, we thought that the lesion was a tuberculosis-related chorioretinal scar and so he was treated with anti-tuberculosis medications. There was a recurrent bilateral anterior uveitis during three months from the initial visit. RESULTS: After 14 months, he was examined by otorhinolaryngologist due to a saddle nose deformity and Wegener's granulomatosis was diagnosed based on positive Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and nasal mucosal biopsy. At that time, ocular examination revealed the necrotizing scleritis in both eyes and orbital CT showed bony destruction of medial and inferior orbital wall without proptosis in both eyes. We had treated with oral cyclophosphamide and prednisone. CONCLUSIONS: We experienced a case of Wegener's granulomatosis with chorioretinal scar misdiagnosed as ocular tuberculosis. In conclusion, we should differentially diagnose Wegener's granulomatosis from suspected ocular tuberculosis.

Clinical Aspects of 273 Patients with Visual Disability

PURPOSE: To report clinical features of visually disabled people by newly revised legal blindness criteria. METHODS: A prospective evaluation of all blind registrations was conducted at Dongguk University Hospital from January 2000 to December 2000. Detailed ophthalmologic evaluations were performed and the review of the diagnosis was done in order to find out the cause of the visual disability. RESULTS: There were 273 patients (343 eyes) for newly registered blindness. Of these, 190 (69.6%, 190/273) were men and mean age was 53.8+/-15.48. The sixth degree visual disability was most common (74.0%, 202/273) according to the newly revised legal blindness criteria, and most common cause of blindness was trauma (38.2%, 131/343). Government office advised 122 patients (44.7%, 122/273) to register legal blindness . CONCLUSION: Further nationwide epidemiological survey for legal visual disability is required by standardized classification and criteria.

A Case of Endogenous endophthalmitis Caused by Klebsiella Pneumoniae from Emphysematous Pyelonephritis

PURPOSE: To report a case of Klebsiella pneumoniae endogenous endophthalmitis secondary to renal or urinary tract infection such as emphysematous pyelonephritis. METHODS: A-56-year-old woman with diabetes mellitus and emphysematous pyelonephritis was reterred to us in consultation for visual loss in her right eye for 5 days. Ophthalmologic evaluation and intervention were performed. RESULTS: Culture revealed Klebsiella pneumoniae from vitreous tap of the right eye. Systemic antibiotics, intravitreous antibiotics injection and vitrectomy were performed, but the eye showed progressive worsening to phthisis. CONCLUSIONS: A high index of suspicion of Klebsiella pneumoniae endogenous endophthalmitis must be carried in patients with renal or urinary tract infection such as emphysematous pyelonephritis as well as hepatobiliary disease such as pyogenic liver abscess.

A case of Traumatic Asphyxia Associated with Ophthalmic Manifestation

PURPOSE: Traumatic asphyxia is a rare clinical syndrome characterized by cervicofacial cyanosis, edema, and multiple petechiae after a severe chest crush injury, and ophthalmic involvement includes violaceous discoloration of lid, lid edema, bulbar subconjunctival hemorrhage, exophthalmos and retinal hemorrhage. The authors experienced a case of traumatic asphyxia with typical ophthalmic manifestations after a crush chest injury, and we report this case with literature review. METHODS: A-54-year old man was consulted for bilateral proptosis after a crush chest injury. Ophthal-mologice valuation and intervention were performed. RESULT: Right eye was not checked due to previous corneal opacity, but visual acuity was 0.8 and IOP was 45 mmHg in left eye. There were bilateral proptosis and severe bulbar subconjunctival hemorrhage, and orbital computed tomography showed orbit fat interposed between globe and medial orbital wall. IOP was controlled with medications and other clinical signs including proptosis showed progressive improvement.

Clinical Picture of the Pediatric Ocular Trauma

A prospective observational study was conducted of all children with ocular trauma who visited Dongguk University Pohang Hospital from January 1999 to December 1999. Current clinical features were evaluated and demographic and etiologic factors were determined. There were 56 patients, representing 15.4%of all ocular trauma patients. Among them, 42 children(75.0%)were boys, and 14(25.0%)were girls. Accidents at home were the commonest cause of injury in 0~5 years of age group, sporting activity in 6~10 age group, and accidents at school and other places in 11~15 age group. The types of injury were categorized into five groups. Many patients sustained more than one type of injury;therefore the total number of injuries(94 cases)is greater than the number of patients. Extraocular(33.0%)and nonperforating anterior globe injuries(47. 9%)occurred most commonly, whereas perforating globe injury occurred in only one case. In comparison with previous reports, incidence of pediatric ocular trauma and especially incidence of perforating ocular injury decreased. Even though all pediatric ocular trauma is not preventable, supervision for preventable causes by parents and teachers is needed.

Sports-related Ocular Injuries

PURPOSE: To evaluate etiology, risk factors and clinical features in eyes with sports-related injuries. METHOD: A prospective evaluation of all patients presenting with a sports-related ocular injury was conducted at Dongguk University Pohang Hospital from January 1999 to December 1999. RESULT: There were 29 patients, representing 8.0% of all ocular trauma patients. Male was injured more often than female by a ratio of 6.25:1, and the mean age was 25.8+/-14.3 years. Soccer accounted for 37.9% and basketball accounted for 13.8% of all injuries. The mechanism most frequently responsible for injuries was direct ball trauma(51.7%). Six patients(20.7%) wore spectacles, whereas none of patients wore protective eye wear, at the time of their injury. Lid subcutaneous hemorrhage or edema(12 eyes) was the most common injury, and corneal abrasion(11 eyes) and retinal edema(7 eyes) occurred frequently. Traumatic hyphema and traumatic iritis occurred in 5 eyes, respectively. CONCLUSION: Sports-related ocular trauma is one of the significant causes of ocular morbidity. Even though all sports-related ocular trauma is not preventable, increased education such as use of certified protective eye wear is needed if the frequency or severity of injuries is to be decreased.

A Case of Thelazia Callipaeda Conjunctival Infestation

Thelaziasis in human is an oppotunistic infection.The worms usually lie in the conjunctival sac or in the lacrimal apparatus, causing foreign body sensation, tearing, conjunctival irritation and subconjunctival hemorrhage. Corneal abrasion and corneal opacity may develop.In most cases, patients find the worms themselves and visit the hospital. The authors experienced and confirmed a case of human subconjunctival infestation of 3 worms of Thelazia callipaeda in 6 months old infant in Kyungpook province.We report this case with literature review.

Canaliculodacryocystorhinostomy in Canalicular Obstruction

The authors performed canaliculodacryocystorhinostomy using operating microscope to resect canalicular obstruction area and reconstruct the excretory system with silicone tube insertion in patients with epiphora due to canalicular obstruction. We performed 50 operations on 44 patients with canalicular obstruction from March 1994 to December 1998. The average age of patients was 56.4 years old and the average follow-up period was 7.2 months. The canalicular obstruction site was as follows :medial common canalicular area was 13 eyes, lateral common canalicular area 20 eyes, lower canalicular area 11 eyes and upper and lower canalicular area 6 eyes. The surgical success rate was 78%. Thus authors conclude that canaliculodacryocystorhinostomy can reduce complications of a Jones tube and one can expect the physiological drainage of tears through reconstructed canaliculus.

Complications Associated with Intravitreal Silicone Oil Injection

A retrospective study is reported on 96 eyes treated by pars plana vitrectomy and intravitreal silicone oil tamponade for treatment of complicated retinal detachment to evaluate ocular complications secondary to intravitreal silicone oil complete retinal reattachment occurred in 59(61.5%) of 96 eyes at initial surgery. Recurrent retinal detachment and recurrent proliferative vitreoretinopathy occurred in 19(32.3%) and 15(25.4%) of 59 eyes respectively. The major complications associated with intravitreal silicone oil were cataract(96.6% of phakic eyes) and keratopathy(29.2%) and their peak onset was around 3 months after intravitreal silicone oil injection. Other complications were intraocular pressme elevation, hypotony, hyphema, fibrin reaction in anterior chamber, etc. These findings suggest that even though intravitreal silicone oil injection is a valid procedure for treatment of complicated retinal detachment, its removal is recommended after about 3 months before development of vision-threatening complicatoins such as cataract and keratopathy.